Mathias Claeys1,2, Guido Claessen1,2,3, Piet Claus1, Ruben De Bosscher1,2, Christoph Dausin4, Jens-Uwe Voigt1,2, Rik Willems1,2, Hein Heidbuchel5, Andre La Gerche1,3. 1. Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium. 2. Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium. 3. Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia. 4. Department of Movement Sciences, KU Leuven, Tervuursevest 101, Box 1500, BE-3001 Leuven, Belgium. 5. Division of Cardiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, BE-2650 Edegem, Belgium.
Abstract
AIMS: Athletes with right ventricular (RV) arrhythmias, even in the absence of desmosomal mutations, may have subtle RV abnormalities which can be unmasked by deformation imaging. As exercise places a disproportionate stress on the right ventricle, evaluation of cardiac function and deformation during exercise might improve diagnostic performance. METHODS AND RESULTS: We performed bicycle stress echocardiography in 17 apparently healthy endurance athletes (EAs), 12 non-athletic controls (NAs), and 17 athletes with RV arrhythmias without desmosomal mutations (EI-ARVCs) and compared biventricular function at rest and during low (25% of upright peak power) and moderate intensity (60%). At rest, we observed no differences in left ventricular (LV) or RV function between groups. During exercise, however, the increase in RV fractional area change (RVFAC), RV free wall strain (RVFWSL), and strain rate (RVFWSRL) were significantly attenuated in EI-ARVCs as compared to EAs and NAs. At moderate exercise intensity, EI-ARVCs had a lower RVFAC, RVFWSL, and RVFWSRL (all P < 0.01) compared to the control groups. Exercise-related increases in LV ejection fraction, strain, and strain rate were also attenuated in EI-ARVCs (P < 0.05 for interaction). Exercise but not resting parameters identified EI-ARVCs and RVFWSRL with a cut-off value of >-2.35 at moderate exercise intensity had the greatest accuracy to detect EI-ARVCs (area under the curve 0.95). CONCLUSION: Exercise deformation imaging holds promise as a non-invasive diagnostic tool to identify intrinsic RV dysfunction concealed at rest. Strain rate appears to be the most accurate parameter and should be incorporated in future, prospective studies to identify subclinical disease in an early stage. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Athletes with right ventricular (RV) arrhythmias, even in the absence of desmosomal mutations, may have subtle RV abnormalities which can be unmasked by deformation imaging. As exercise places a disproportionate stress on the right ventricle, evaluation of cardiac function and deformation during exercise might improve diagnostic performance. METHODS AND RESULTS: We performed bicycle stress echocardiography in 17 apparently healthy endurance athletes (EAs), 12 non-athletic controls (NAs), and 17 athletes with RV arrhythmias without desmosomal mutations (EI-ARVCs) and compared biventricular function at rest and during low (25% of upright peak power) and moderate intensity (60%). At rest, we observed no differences in left ventricular (LV) or RV function between groups. During exercise, however, the increase in RV fractional area change (RVFAC), RV free wall strain (RVFWSL), and strain rate (RVFWSRL) were significantly attenuated in EI-ARVCs as compared to EAs and NAs. At moderate exercise intensity, EI-ARVCs had a lower RVFAC, RVFWSL, and RVFWSRL (all P < 0.01) compared to the control groups. Exercise-related increases in LV ejection fraction, strain, and strain rate were also attenuated in EI-ARVCs (P < 0.05 for interaction). Exercise but not resting parameters identified EI-ARVCs and RVFWSRL with a cut-off value of >-2.35 at moderate exercise intensity had the greatest accuracy to detect EI-ARVCs (area under the curve 0.95). CONCLUSION: Exercise deformation imaging holds promise as a non-invasive diagnostic tool to identify intrinsic RV dysfunction concealed at rest. Strain rate appears to be the most accurate parameter and should be incorporated in future, prospective studies to identify subclinical disease in an early stage. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Dermot Phelan; Jonathan H Kim; Michael D Elliott; Meagan M Wasfy; Paul Cremer; Amer M Johri; Michael S Emery; Partho P Sengupta; Sanjay Sharma; Matthew W Martinez; Andre La Gerche Journal: JACC Cardiovasc Imaging Date: 2020-10-28
Authors: Ruben De Bosscher; Christophe Dausin; Kristel Janssens; Jan Bogaert; Adrian Elliott; Olivier Ghekiere; Caroline M Van De Heyning; Prashanthan Sanders; Jonathan Kalman; Diane Fatkin; Lieven Herbots; Rik Willems; Hein Heidbuchel; André La Gerche; Guido Claessen Journal: BMJ Open Sport Exerc Med Date: 2022-03-18